title: Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques.
abstract: BACKGROUND
  Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge.
  
  
  METHODS
  One hundred consecutive miniCABG cases performed using internal mammary artery (IMA) grafting +/- coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death.
  
  
  RESULTS
  For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 +/- 6.35 vs. 12.24 +/- 6.24 hours), hospital stay (3.77 +/- 1.51 vs. 6.38 +/- 2.23 days), and transfusion (0.16 +/- 0.37 vs. 1.37 +/- 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = -2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4-7.6), largely from lower target-vessel patency.
  
  
  CONCLUSIONS
  MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency.
authors.affiliation: Division of Cardiac Surgery, Boston University School of Medicine, Boston, MA 02114, USA. robert.poston@bmc.org
authors.forename: Robert S
authors.initials: RS
authors.lastname: Poston
authors.forename: Richard
authors.initials: R
authors.lastname: Tran
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Marty
authors.initials: M
authors.lastname: Reynolds
authors.forename: Ingrid
authors.initials: I
authors.lastname: Connerney
authors.forename: Barry
authors.initials: B
authors.lastname: Reicher
authors.forename: David
authors.initials: D
authors.lastname: Zimrin
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Bartlett
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012371:Robotics / Q000191:economics; D016896:Treatment Outcome; D014481:United States